International Register for Classification of ships - Established 1828

REQUEST FOR SURVEY

The undersigned,
(Your name) / acting as
Master / Superintendent / Agent of the
(Company name) / requests
Bureau Veritas in (Country name) / to attend on board the ship
(Ship name)
for carrying out following surveys / BV Register No.

* Surveys request :

Special survey Hull : / Commence / Partial / Complete
Special survey Machinery : / Commence / Partial / Complete
Special survey Automation : / Special survey Refrigerating Installation
Renewal survey Gas installation / Renewal survey chemical installation
Continuous survey : / Hull / Machinery / Refrig. Inst. / Auto / PMS / VeriSTAR M
Annual survey : / Hull / Hull Structure / Machinery / Boiler / Auto / Refrigerate. Inst.
Intermediate survey : / Hull / Gas install. / Chemical installations
Occasional survey :
Docking survey : / Periodical / Occasional / Dry dock / In water
Boiler survey : / Renewal / Complete / Oil fired / Exhaust gas / Composite
Propeller shaft survey : / Complete / Partial/Modified
Load line survey : (Multiple FB ? ) / Renewal / Periodical Insp’ ( = Annual) / Occasional
Safety construction : / Renewal / MAS or IS / Occasional / IS Oil tanker 10 Yrs+
Safety equipment : / Renewal / MAS or PS / Occasional / IS Oil tanker 10 Yrs+
Safety EXEMPTION Cert’ / Renewal / IMSBC Code SOC Renewal
Boat Launching Appliances Test : / Quinquennial / Embarkation Ladders 5 Y Load Test
Document of Compliance : / 5 Y Renewal / Annual Occasional / ( Dangerous Goods )
Safety radiotelegraphy : / Renewal / Periodical ( = Annual for Harmonized sys’ ) Occasional
IOPP : / Renewal / IS / MAS/AS / Occasional
IAPP : / Renewal / IS / MAS/AS / Occasional
Sewage ( MARPOL Annex IV ) : / Renewal / Garbage (MARPOL Annex V) / Attestation Renewal
Anti – Fouling System : / Certificate issue / Endorsement
Fitness chemical / gas carrier / Renewal / IS / MAS / Occasional
NLS (Noxious Liquids Substances) / Renewal / IS / MAS
Inert gas : / Renewal / IS / MAS
Ballast Water Management : / Renewal / IS / MAS
Cargo gear survey : / 5 Y Periodical / Quadrennial / Annual Crane Load Test Occasional
Other
* Place & date of survey :
* Contact / Agent name & address :
Tel No. : / Fax No. : / e-mail address :

*All corresponding fees and expenses incurred are to be paid for by :

Name :
Address :
Tel No. : / Fax No. : / e-mail address :
Made at : / On :
Applicant's signature :
Name & title :

The latest published Rules of the Bureau Veritas Marine Branch and the General Condition therein are applicable.

03.2014